Provider Demographics
NPI:1881616902
Name:XYDAS, ANDREAS P (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREAS
Middle Name:P
Last Name:XYDAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15951 FM 529 RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2696
Mailing Address - Country:US
Mailing Address - Phone:281-345-4200
Mailing Address - Fax:281-345-4211
Practice Address - Street 1:15951 FM 529 RD
Practice Address - Street 2:SUITE 140
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2696
Practice Address - Country:US
Practice Address - Phone:281-345-4200
Practice Address - Fax:281-345-4211
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18575122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA10203050Medicaid